Provider Demographics
NPI:1710938766
Name:RYBICKI, KELLY ANNE (DC)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ANNE
Last Name:RYBICKI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05404-1338
Mailing Address - Country:US
Mailing Address - Phone:802-655-0354
Mailing Address - Fax:802-655-0354
Practice Address - Street 1:440 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05404-1338
Practice Address - Country:US
Practice Address - Phone:802-655-0354
Practice Address - Fax:802-655-0354
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0000944111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN0823Medicaid
VTTX7286Medicare PIN